In Women With Fibromyalgia, Perfectionism Found to Impact Functionality

In Women With Fibromyalgia, Perfectionism Found to Impact Functionality

In women with fibromyalgia with ingrained perfectionism, avoiding activities in anticipation of pain negatively impacts functionality. But conversely, persisting in activities to complete tasks has positive effects, a study finds.

These results suggest that giving consideration to a person’s perfectionism level when recommending interventions may help improve the quality of life of some patients, especially women.

The study, “Is Perfectionism Always Dysfunctional? Looking into Its Interaction with Activity Patterns in Women with Fibromyalgia,” was published in the journal Clinical Nursing Research.

In chronic pain disorders such as fibromyalgia, health outcomes are believed to be influenced by psychological, behavioral, and environmental factors. The flexibility model of pain, one scientific tool used by clinicians, posits that patients’ ability to function with chronic pain is affected by their mental well-being, individual goals, and how they engage in activities with respect to their pain, or activity patterns. 

The three major activity patterns are defined as avoiding activity, persisting in activity, and breaking up activity over time (pacing). A specific activity pattern and its effect on functional limitation may be adaptive or maladaptive depending on the context. 

Perfectionism is a personality trait characterized by holding exceedingly high standards, which may be adaptive — i.e. setting high personal behavioral standards — or maladaptive, in which an individual becomes preoccupied with small mistakes. A predisposition for chronic fatigue disorders is associated with perfectionistic personalities and, in fibromyalgia, it can lead to overexertion and difficulty coping with the disease. 

A moderate degree of perfectionist behavior is related to improved functionality, but this interaction has not been investigated. To explore the context-specific approach to managing chronic pain related to fibromyalgia, researchers at Rey Juan Carlos University, in Spain, analyzed the role of perfectionism in influencing activity patterns and functionality. 

A group of 228 women with fibromyalgia, with a mean age of 56.9 and a mean of 12.1 years since diagnosis, were recruited from urban and rural areas in Spain. Activity patterns were determined using the Patterns of Activity Measure-Pain, a self-reported assessment that measures behavior to identify differing patterns. Such patterns include pain avoidance due to anticipation of pain, activity avoidance due to pain, task persistence, excessive persistence — persisting to overexertion — pain-contingent persistence, and pacing. Task persistence is defined as persisting to complete a task despite pain, while pain-contingent persistence is identified as persisting depending on pain level.

The results showed that higher perfectionism is associated with greater activity avoidance, excessive persistence, pain-contingent persistence, and fibromyalgia impact on functioning. In turn, greater fibromyalgia impact correlated with pain avoidance, activity avoidance, excessive persistence, pain-contingent persistence, and pacing to ease pain.

Pain avoidance was associated with greater fibromyalgia impact when perfectionism was medium or high, while task-contingent persistence was associated with better functionality when perfectionism was high.

These results suggest that in some patients with high levels of perfectionism, pain avoidance may be maladaptive but task persistence can be recommended, according to the team.

“This study suggests that the assessment of perfectionism is a key factor in adapting interventions to specific profiles of [fibromyalgia] patients, and future lines of research should assess how both interventions can assist in improving the quality of life and functional limitation in fibromyalgia by modifying levels of perfectionism,” the researchers wrote.

Among the limitations of the study were including only women as well as the incorporation of only one subscale from the Frost Multidimensional Perfectionism Scale to assess perfectionism, the scientists said.